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An unusual complication of an open-head injury: coccidioidal meningitis
D T Morwood1, L S Nichter, V Wong
1Division of Plastic Surgery, Childrens Hospital of Los Angeles, CA 90054-0700.
Abstract:
A case of coccidioidal meningitis following an open-head injury is presented. A 6-year-old boy was ejected from a motor vehicle as it was driven over a cliff, resulting in a severe open-skull fracture with grossly contaminated wounds. The accident occurred in an area in which coccidioidomycosis is endemic, and the causative agent, Coccidioides immitis, is found in high concentration in the soil. In addition to fracture reduction, the child received a course of intrathecal and intravenous amphotericin and achieved a satisfactory clinical response.
Insights
A severe open-head injury in an endemic area led to coccidioidal meningitis in a child. Prompt treatment with amphotericin resulted in a positive clinical outcome, highlighting the importance of timely intervention.
Area of Science:
- Neurology
- Infectious Diseases
- Trauma Surgery
Background:
- Coccidioidomycosis is a fungal infection endemic to specific regions, particularly the southwestern United States.
- Open-head injuries present a significant risk for secondary infections due to direct pathogen exposure.
- Coccidioides immitis, the causative agent, thrives in soil and can be introduced through traumatic wounds.
Observation:
- A 6-year-old boy sustained a severe open-skull fracture with heavily contaminated wounds after a motor vehicle accident.
- The accident occurred in a region with a high prevalence of Coccidioides immitis in the soil.
- The patient developed coccidioidal meningitis, a serious central nervous system complication.
Findings:
- Surgical intervention included fracture reduction to address the traumatic injury.
- The patient received a combination of intrathecal and intravenous amphotericin B for treatment.
- A satisfactory clinical response was observed following the antifungal therapy.
Implications:
- This case underscores the potential for fungal meningitis following traumatic brain injury in endemic areas.
- Early diagnosis and aggressive antifungal treatment are crucial for managing coccidioidal meningitis.
- Intrathecal and intravenous amphotericin B can be effective in treating severe cases of coccidioidal meningitis post-trauma.